The most heartbreaking movies about addiction

“In the end, it’s all nice.” The characters in Darren Aronofsky’s adaptation of Hubert Selby’s 1978 novel are addicted to more than heroin and diet pills; they’re hooked on the false hope of the American dream. Clint Mansell’s ominous score tips you off from the very beginning that this isn’t going to end well, but nothing can prepare you for how bad it’s going to get — and how excruciatingly long it’s going to take for these people to hit rock bottom. 

Michael Keaton was coming off a string of successful comedies when he wowed critics with his first dramatic performance in this relentlessly unsentimental film about addiction and the rough, never-ending road that is recovery. Keaton is perfectly cast as a fast-talking, hard-drinking, cocaine-hoovering real estate salesman whose good times come to a crashing halt when a woman he picks up at a bar overdoses. Glenn Gordon Caron’s film was one of the first Hollywood films to accurately depict 12-step programs, and while it’s a bit melodramatic, it doesn’t let Keaton’s character off the hook. The 30-day chip he earns at the end of the film is just the beginning.

Steve McQueen’s grim drama stars Michael Fassbender as a successful New York City bachelor driven into a downward spiral due to an all-consuming sex addiction. The film is unsparing in its depiction of Fassbender’s compulsion and offers no easy answers or self-help platitudes. Even though the protagonist knows he’s harming himself and his loved ones, he’s a slave to his compulsion. Addiction is ugly, and McQueen never looks away.

Gus Van Sant’s indie film classic follows a group of addicts driving around the country stealing prescription drugs from pharmacies. While Van Sant doesn’t glamorize this low lifestyle, he isn’t in a moralizing mood either. He’s fascinated by these characters (played with scrappy authenticity by Matt Dillon, Kelly Lynch, James LeGros and Heather Graham), and wants his audience to understand the appeal of a life dedicated to the obtaining of momentary highs. 

Debra Granik’s feature debut established her straightaway as a master chronicler of mundane human despair — in this case, a working-class mother who relies on cocaine to get her through the dreary day. This is the unvarnished, indie-film answer to “Clean and Sober," as Granik eschews the requisite elevated stakes of studio-movie storytelling to examine in plain detail an ordinary American struggling to stay sober for the sake of her family. 

In Tennessee Williams’s classic play, Brick Pollitt uses alcohol as a coping mechanism ostensibly to blot out the guilt of his best friend’s suicide. But he’s really running from the reality of his latent homosexuality. This gets brushed aside in Richard Brooks’ film adaptation of the play, but if you know the text well, you can feel Paul Newman hooking into the abject pain of a man who cannot be who he truly is.

Robert Altman’s comedy about two degenerate gamblers (Elliott Gould and George Segal) chasing the highs and lows of winning and losing is a ramshackle charmer that leaves a bitter aftertaste when you realize these men are as addicted to losing as they are to winning. No one walks away from a big win satisfied with their haul. They want more. And the highs of winning aren’t so high without the lows of losing.

Adolescent drug addiction is the subject of Uli Edel’s adaptation of actress-musician Christiane Felscherinow’s autobiography, and it does for heroin what Oliver Stone did for the Vietnam War in “Platoon” — make something you know to be bad look as though it is hell on earth. While it’s heartbreaking in the way that films about young people’s lives being destroyed by addiction ought to be, it’s more sensationalistic than humanistic.

Nicolas Cage won a Best Actor Oscar for his fiercely committed portrayal of a one-time successful screenwriter who, having boozed his way out of a family and general employability, heads to Las Vegas with all the money he has left and proceeds to drink himself to death. Mike Figgis’ film is a portrait of an addict beyond salvation — a man who has nothing to live for and no will to redeem himself.

One year before Blake Edwards became a master of madcap comedy with “The Pink Panther," he directed this devastating drama about a married couple’s descent into co-dependent alcoholism. Jack Lemmon plays an elbow-bending PR exec who falls for his teetotaler secretary (an excellent Lee Remick). Soon they’re full-blown, round-the-clock drunks, which leads one to sobriety and the other to ruin. Fifteen years later, Edwards’ film has lost none of its power.

Jason Patric and Jennifer Jason Leigh play undercover narcotics detectives who get hooked on the product they’re trying to keep off the street in Lili Fini Zanuck’s adaptation of Kim Wozencraft’s semiautobiographical novel. Though UC cops obviously aren’t supposed to use on the job, it’s clear that the only way they can effectively blend in with their quarry is to be believable as users — and this is just one more reason the war on drugs might be considered a total crock.

Though dark and depressing at times, Danny Boyle’s “Trainspotting” is far too exhilarating a cinematic experience to count as a heartbreaking depiction of addiction. The sequel, however, which catches up with Renton, Sick Boy, Begbie and Spud 20 years later, is infused with the melancholy of wasted youth and squandered potential. Kicking the habit doesn’t mean happily ever after. 

Billy Wilder and Charles Brackett’s straight-faced adaption of Charles R. Jackson’s semiautobiographical novel is one of the first Hollywood films to tackle the disease of alcoholism head on. Ray Milland stars as a hard-drinking New York City writer who circles the drain in ways that are both realistic (he sells his typewriter for booze money) and silly (a whiskey bender triggers a nightmarish hallucination of a bat devouring a mouse in a hotel room wall). The film won four Oscars including Best Picture and Actor.

“They wouldn’t send us any money! They said we’d spend it on drugs!” “We would!” The doomed love affair between Sex Pistols bassist Sid Vicious and his girlfriend-manager, Nancy Spungen, is a sad study in codependency, and Alex Cox’s brilliant dramatization of their relationship suggests they were destined to find and destroy each other. There’s something horribly romantic about this. In recent interviews, Cox regrets the “touch-feely” ending. “We should have shown Sid dying in a pool of vomit,” he says.

Frank Sinatra has a red-hot craving for “drugs” (probably heroin; the film never specifies) in Otto Preminger’s 1955 crime drama, “The Man with the Golden Arm." This is a classic Hollywood “Problem Picture," and while it’s fairly dated in its treatment of addiction, it’s fascinating to watch Ol’ Blue Eyes take a crack at method-style acting as a recently paroled poker dealer struggling to stay sober. In terms of vulnerability, it’s an interesting tune-up for his masterful performance four years later in “Some Came Running."

When the flow of heroin dries up in New York City, desperate junkies, in a “panic," turn each other in to curry favor with the NYPD. This is an unlikely subject for a romantic drama, but Jerry Schatzberg, working from a perceptive screenplay by Joan Didion and John Gregory Dunne, imbues it with a heartbreaking authenticity. It certainly doesn’t hurt that his cast includes the prestardom likes of Al Pacino and Raul Julia.

Twin gynecologists Elliot and Beverly Mantle (Jeremy Irons in a brilliant dual performance) are already suffering from a whole host of psychological issues before they begin abusing prescription drugs in David Cronenberg’s hugely depressing body horror masterpiece. But it’s the pills that serve as the catalyst for their downward spiral and ultimate demise. And in case you’re wondering, attempting to sync up your narcotic intake with another addict’s will not help you wean them off the drug. Quite the opposite actually!

Richard Linklater’s adaptation of Philip K. Dick’s brain-breaking sci-fi novel is set in a near-future United States where addicts are hooked on a personality-splitting narcotic called Substance D. Linklater makes vivid use of the rotoscope animation he employed on “Waking Life," immersing viewers in the addled mind of an addict losing his grip on reality. It’s a horribly compelling place to be. 

Given America’s ongoing opioid crisis, Nicholas Ray’s “Bigger Than Life” is more relevant today than it was at the time of its release in 1956. James Mason stars as a schoolteacher who is prescribed cortisone to treat a potentially fatal arterial infection. The drug proves habit forming, causing him to behave strangely and eventually turn violent. Ray’s little-seen CinemaScope masterpiece is now available via the Criterion Collection and FilmStruck, and it demands to be seen on the biggest screen in your house.

Based on Arielle Holmes’ as-yet-unpublished memoir, Josh and Benny Safdie’s “Heaven Knows What” is an all-too-real dramatization of the junkie life in today’s New York City. It’s a sleazy, dingy experience, but the Safdies cut the extreme desperation with moments of unexpected transcendence. They’re brief highs in an otherwise grueling but essential film.